| NPI | 1003906595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 176233) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 82514) |
| 207W00000X Ophthalmology (Licence: AR E-3917) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2026-06-29 |